Tc
Mon, Jan-22-07, 17:16
http://clinical.diabetesjournals.org/cgi/content/full/23/1/6
The Business of Diabetes
The Coming Crisis in Continuing Education in Diabetes:
Resolvable Issues and Novel Solutions Steven B. Leichter, MD,
FACP, FACE
Introduction Top Introduction The Need for CME... Summary
REFERENCES
In a previous article,1 a broad theoretical concept was
presented that suggested that physician participation in
continuing medical education
(CME) programs was diminishing and would continue to diminish.
The reasons suggested for this were:
Growing dependence on pharmaceutical companies for financial
support of CME programs
Increasing pressure for regulatory oversight of educational
programs sponsored by pharmaceutical companies
Increasing and negative imposition of "ethical standards" for
physician behavior by pharmaceutical companies in CME
interactions
Despite regulatory oversight, growing pharmaceutical company
control of the development and marketing of physician
"experts" for CME, whether promotional or accredited
With increased regulatory oversight, a decline in the degree
of creativity and level of sophistication of such programs,
converting many CME or promotional programs into
"infomercials."
According to unofficial but authoritative sources in various
pharmaceutical companies, these influences have resulted in a
substantial decline in physician participation in CME
programs. Despite these trends, there is no evidence that the
current directions will be altered in the near future.
Altering these characteristics would be very desirable in
diabetes care.
The Need for CME in Diabetes Care Top Introduction The
Need for CME... Summary REFERENCES
Multiple studies have confirmed that the prevalent level of
care for diabetic patients is demonstrably deviant from
recommended guidelines and procedures.2-7 This has been
documented in various care settings, including primary care,
family practice, and large urban managed care organizations.
Despite vigorous efforts on the part of the American Diabetes
Association (ADA) and other organizations to remedy these
deviations, there is no compelling evidence that such efforts
have substantially improved these gaps in care. A study on the
impact of the Canadian Diabetes Association's clinical
practice guidelines for postpartum screening of pregnant women
with gestational diabetes for type 2 diabetes demonstrated
that the guidelines had no significant effect.8 The failure of
such educational efforts in diabetes reflects a widespread
failure of CME efforts to improve clinical practice.9 Part of
this problem relates to the relevance and complexity of
guidelines or clinical practice recommendations and the ease
with which these changes in care patterns fit into existing
practice.10
These issues emphasize areas of concern in professional
education in diabetes care. They underscore how important
postgraduate physician education in diabetes care is and how
concerned we all should be about declines in physician
interest in such opportunities. They document how important it
is for educational efforts to be driven by physician need and
interest rather than by the self-interested agendas of outside
organizations or corporations. And they suggest that the
imposition of new obstacles to physician participation, such
as unpopular "ethical guidelines," must be modified to remove
their barrier effect.
Barrier 1: Application of "Ethical Guidelines" on Postgraduate
Physician Education As most health professionals know, major
pharmaceutical companies, through their professional
organization Pharmaceutical Research and Manufacturers of
America (PhRMA), recently issued the PhRMA Code on Interaction
with Health Professionals."11 This extensive, 56-page document
covers a number of important issues regarding the ethical
interaction of companies with health professionals, including
interactions in the conduct of company-sponsored CME programs.
This year, the Advanced Medical Technology Association adopted
a similar code of conduct.12
The implementation of these guidelines has included certain
key changes in how physicians could participate in
corporate-sponsored educational programs. First, physicians'
spouses or other guests who are not health professionals or
who have work responsibilities not clearly relevant to the
educational program cannot attend. This restriction is
enforced by most companies even if the attendees are willing
to pay for whatever food or beverages are provided to their
guests at the program. Second, companies cannot spend more
than a "modest" amount of money on the food or beverages at
these programs. Third, health professionals can attend
out-of-town programs only if they are willing to accept
"reasonable" travel arrangements. Finally, guests may
accompany health professionals to out-of-town programs only if
the professionals or guests pay for whatever travel, food, and
beverages are provided.
While these changes sound highly ethical and appropriate, it
is one of the most open secrets in the health care industry
that, when implemented, they have had an extremely negative
effect on physician participation in educational programs and
physician attitudes toward the process. Although many
recognize pressure from the federal government (specifically
the Office of the Inspector General [OIG]) on vendor companies
to follow such guidelines, the manner in which they are
implemented may appear high-handed to many health
professionals. Regardless of cause, large PhRMA companies are
imposing a code of conduct on their health professional
customers. But the hole in their stance is that no other
groups of customers or influential members of the community
are subjected to the same code of conduct.13,14 This includes
managers or executives of large managed care organizations,
pharmacy benefits executives, congressional staff, and elected
officials.
Perhaps the most controversial part of the codes, as they
affect health professionals, is their requirement that spouses
or guests be excluded from attendance, even if the health
professionals pay for their guests' meals. Informal but broad
feedback from pharmaceutical representatives of various
companies indicates that this one stipulation has been the
most influential in discouraging physician participation at
educational programs. Whether this restriction is well-founded
or not, it is perhaps the single most important obstacle to
health professional attendance at educational programs.
There should also be concern about the application of rules
regarding attendance at out-of-town meetings. A previous
article15 noted that the engagement of third-party vendors by
pharmaceutical companies may lead to abuses. The potential for
abuse, by which these vendors may increase their profits,
should be monitored carefully. In their zeal to demonstrate
forcefully that they are adhering to ethical guidelines, PhRMA
companies are allowing third-party vendors to charge attendees
exorbitant amounts for food and transportation to and from
airports for their spouses or other guests. At one recent
educational conference, the organizing vendor charged
attendees more than $800 for two airport transports and three
meals for their spouses/guests. The same services purchased
directly would have cost only $280!
Another issue is whether travel restrictions imposed on
conference participants under the guise of these guidelines
are truly required by PhRMA guidelines. There is a fine line
between ethical behavior and poor treatment of health
professionals.
A solution for these problems is clearly needed to improve
enthusiasm for educational conferences while adhering to the
ethical requirements of the OIG. Corporate advocacy of ethical
conduct for health professionals should be presented in a
positive and cooperative fashion, not in the high-handed
directive fashion in which it is presently offered. PhRMA
companies should reconsider whether, under ethical codes,
health professionals may be permitted to bring spouses or
other guests to such programs. Each vendor may individually
decide whether providers should pay the food and beverage
costs for their guests. Third-party vendors of educational
conferences should be required to provide transportation,
food, and beverages to attendees' guests at their cost, not at
an inflated estimation of what health professionals should be
charged. Making these changes should have a positive effect on
health professionals' willingness to participate in
corporate-sponsored programs.
This would benefit all concerned about diabetes care. Given
the large number of existing medical products and the number
of new products that will become available during the next 5
years, encouraging provider access to educational programs
should be a priority.
Barrier 2: Increasing Restrictions on Accredited Programs On
28 September 2004, the Accreditation Council for Continuing
Medical Education (ACCME), under pressure from the OIG,
announced strict new guidelines regarding speaker involvement
with vendor companies.16 All parties involved in
ACCME-approved programs have until May 2005 to become
compliant with these guidelines. Under these guidelines, any
individual who has any demonstrable financial relationship
with a corporate sponsor cannot help plan a program or speak
on a subject relevant to the products of that sponsor at an
ACCME-accredited program. Knowledgeable experts on CME
programs believe that these changes will alter professional
education substantially.
One worry is that these efforts of the ACCME will exclude many
recognized experts from speaking about areas relevant to their
expertise. Pharmaceutical companies have had substantial
influence in developing and marketing experts on new therapies
or devices. Also, pharmaceutical companies are an important
source of funding for ACCME programs. Obviously, these new
guidelines will encourage ACCME-accredited programs and
pharmaceutical companies to develop new relationships for
funding such programs and for developing credible experts.
These changes are so new that no answers are yet apparent
regarding how diabetes CME will be affected. However, these
changes may strengthen the role of professional organizations,
such as the ADA, in developing experts. Such a development
would clearly confer more independence in professional
education and emphasize the benefits of having ethical
organizations assume a greater role.
Summary Top Introduction The Need for CME... Summary
REFERENCES
Current trends in both objective restrictions and subjective
attitudes may be decreasing, rather than encouraging, provider
participation in educational programs. Amelioration of these
trends may substantially reduce these adverse effects. The
introduction of new guidelines for participation in planning
or speaking at educational meetings will have a profound
effect on professional education. These changes may work to
strengthen the independence and objectivity of continuing
education in the long run.
Footnotes
Steven B. Leichter, MD, FACP, FACE, is co-director of the
Columbus Research Foundation and president of Endocrine
Consultants, PC, in Columbus, Ga. He is a professor of
medicine at Mercer University School of Medicine in Macon, Ga.
**********
http://www.endoconsult.net/about.cfm
http://www.endoconsult.net/hot-information.cfm
Hot info about obesity and no mention of nutrition, only pills
and hormones.
http://www.diabetesincontrol.com/modules.php?name=News&file=p-
rint&sid=2509
TC
The Business of Diabetes
The Coming Crisis in Continuing Education in Diabetes:
Resolvable Issues and Novel Solutions Steven B. Leichter, MD,
FACP, FACE
Introduction Top Introduction The Need for CME... Summary
REFERENCES
In a previous article,1 a broad theoretical concept was
presented that suggested that physician participation in
continuing medical education
(CME) programs was diminishing and would continue to diminish.
The reasons suggested for this were:
Growing dependence on pharmaceutical companies for financial
support of CME programs
Increasing pressure for regulatory oversight of educational
programs sponsored by pharmaceutical companies
Increasing and negative imposition of "ethical standards" for
physician behavior by pharmaceutical companies in CME
interactions
Despite regulatory oversight, growing pharmaceutical company
control of the development and marketing of physician
"experts" for CME, whether promotional or accredited
With increased regulatory oversight, a decline in the degree
of creativity and level of sophistication of such programs,
converting many CME or promotional programs into
"infomercials."
According to unofficial but authoritative sources in various
pharmaceutical companies, these influences have resulted in a
substantial decline in physician participation in CME
programs. Despite these trends, there is no evidence that the
current directions will be altered in the near future.
Altering these characteristics would be very desirable in
diabetes care.
The Need for CME in Diabetes Care Top Introduction The
Need for CME... Summary REFERENCES
Multiple studies have confirmed that the prevalent level of
care for diabetic patients is demonstrably deviant from
recommended guidelines and procedures.2-7 This has been
documented in various care settings, including primary care,
family practice, and large urban managed care organizations.
Despite vigorous efforts on the part of the American Diabetes
Association (ADA) and other organizations to remedy these
deviations, there is no compelling evidence that such efforts
have substantially improved these gaps in care. A study on the
impact of the Canadian Diabetes Association's clinical
practice guidelines for postpartum screening of pregnant women
with gestational diabetes for type 2 diabetes demonstrated
that the guidelines had no significant effect.8 The failure of
such educational efforts in diabetes reflects a widespread
failure of CME efforts to improve clinical practice.9 Part of
this problem relates to the relevance and complexity of
guidelines or clinical practice recommendations and the ease
with which these changes in care patterns fit into existing
practice.10
These issues emphasize areas of concern in professional
education in diabetes care. They underscore how important
postgraduate physician education in diabetes care is and how
concerned we all should be about declines in physician
interest in such opportunities. They document how important it
is for educational efforts to be driven by physician need and
interest rather than by the self-interested agendas of outside
organizations or corporations. And they suggest that the
imposition of new obstacles to physician participation, such
as unpopular "ethical guidelines," must be modified to remove
their barrier effect.
Barrier 1: Application of "Ethical Guidelines" on Postgraduate
Physician Education As most health professionals know, major
pharmaceutical companies, through their professional
organization Pharmaceutical Research and Manufacturers of
America (PhRMA), recently issued the PhRMA Code on Interaction
with Health Professionals."11 This extensive, 56-page document
covers a number of important issues regarding the ethical
interaction of companies with health professionals, including
interactions in the conduct of company-sponsored CME programs.
This year, the Advanced Medical Technology Association adopted
a similar code of conduct.12
The implementation of these guidelines has included certain
key changes in how physicians could participate in
corporate-sponsored educational programs. First, physicians'
spouses or other guests who are not health professionals or
who have work responsibilities not clearly relevant to the
educational program cannot attend. This restriction is
enforced by most companies even if the attendees are willing
to pay for whatever food or beverages are provided to their
guests at the program. Second, companies cannot spend more
than a "modest" amount of money on the food or beverages at
these programs. Third, health professionals can attend
out-of-town programs only if they are willing to accept
"reasonable" travel arrangements. Finally, guests may
accompany health professionals to out-of-town programs only if
the professionals or guests pay for whatever travel, food, and
beverages are provided.
While these changes sound highly ethical and appropriate, it
is one of the most open secrets in the health care industry
that, when implemented, they have had an extremely negative
effect on physician participation in educational programs and
physician attitudes toward the process. Although many
recognize pressure from the federal government (specifically
the Office of the Inspector General [OIG]) on vendor companies
to follow such guidelines, the manner in which they are
implemented may appear high-handed to many health
professionals. Regardless of cause, large PhRMA companies are
imposing a code of conduct on their health professional
customers. But the hole in their stance is that no other
groups of customers or influential members of the community
are subjected to the same code of conduct.13,14 This includes
managers or executives of large managed care organizations,
pharmacy benefits executives, congressional staff, and elected
officials.
Perhaps the most controversial part of the codes, as they
affect health professionals, is their requirement that spouses
or guests be excluded from attendance, even if the health
professionals pay for their guests' meals. Informal but broad
feedback from pharmaceutical representatives of various
companies indicates that this one stipulation has been the
most influential in discouraging physician participation at
educational programs. Whether this restriction is well-founded
or not, it is perhaps the single most important obstacle to
health professional attendance at educational programs.
There should also be concern about the application of rules
regarding attendance at out-of-town meetings. A previous
article15 noted that the engagement of third-party vendors by
pharmaceutical companies may lead to abuses. The potential for
abuse, by which these vendors may increase their profits,
should be monitored carefully. In their zeal to demonstrate
forcefully that they are adhering to ethical guidelines, PhRMA
companies are allowing third-party vendors to charge attendees
exorbitant amounts for food and transportation to and from
airports for their spouses or other guests. At one recent
educational conference, the organizing vendor charged
attendees more than $800 for two airport transports and three
meals for their spouses/guests. The same services purchased
directly would have cost only $280!
Another issue is whether travel restrictions imposed on
conference participants under the guise of these guidelines
are truly required by PhRMA guidelines. There is a fine line
between ethical behavior and poor treatment of health
professionals.
A solution for these problems is clearly needed to improve
enthusiasm for educational conferences while adhering to the
ethical requirements of the OIG. Corporate advocacy of ethical
conduct for health professionals should be presented in a
positive and cooperative fashion, not in the high-handed
directive fashion in which it is presently offered. PhRMA
companies should reconsider whether, under ethical codes,
health professionals may be permitted to bring spouses or
other guests to such programs. Each vendor may individually
decide whether providers should pay the food and beverage
costs for their guests. Third-party vendors of educational
conferences should be required to provide transportation,
food, and beverages to attendees' guests at their cost, not at
an inflated estimation of what health professionals should be
charged. Making these changes should have a positive effect on
health professionals' willingness to participate in
corporate-sponsored programs.
This would benefit all concerned about diabetes care. Given
the large number of existing medical products and the number
of new products that will become available during the next 5
years, encouraging provider access to educational programs
should be a priority.
Barrier 2: Increasing Restrictions on Accredited Programs On
28 September 2004, the Accreditation Council for Continuing
Medical Education (ACCME), under pressure from the OIG,
announced strict new guidelines regarding speaker involvement
with vendor companies.16 All parties involved in
ACCME-approved programs have until May 2005 to become
compliant with these guidelines. Under these guidelines, any
individual who has any demonstrable financial relationship
with a corporate sponsor cannot help plan a program or speak
on a subject relevant to the products of that sponsor at an
ACCME-accredited program. Knowledgeable experts on CME
programs believe that these changes will alter professional
education substantially.
One worry is that these efforts of the ACCME will exclude many
recognized experts from speaking about areas relevant to their
expertise. Pharmaceutical companies have had substantial
influence in developing and marketing experts on new therapies
or devices. Also, pharmaceutical companies are an important
source of funding for ACCME programs. Obviously, these new
guidelines will encourage ACCME-accredited programs and
pharmaceutical companies to develop new relationships for
funding such programs and for developing credible experts.
These changes are so new that no answers are yet apparent
regarding how diabetes CME will be affected. However, these
changes may strengthen the role of professional organizations,
such as the ADA, in developing experts. Such a development
would clearly confer more independence in professional
education and emphasize the benefits of having ethical
organizations assume a greater role.
Summary Top Introduction The Need for CME... Summary
REFERENCES
Current trends in both objective restrictions and subjective
attitudes may be decreasing, rather than encouraging, provider
participation in educational programs. Amelioration of these
trends may substantially reduce these adverse effects. The
introduction of new guidelines for participation in planning
or speaking at educational meetings will have a profound
effect on professional education. These changes may work to
strengthen the independence and objectivity of continuing
education in the long run.
Footnotes
Steven B. Leichter, MD, FACP, FACE, is co-director of the
Columbus Research Foundation and president of Endocrine
Consultants, PC, in Columbus, Ga. He is a professor of
medicine at Mercer University School of Medicine in Macon, Ga.
**********
http://www.endoconsult.net/about.cfm
http://www.endoconsult.net/hot-information.cfm
Hot info about obesity and no mention of nutrition, only pills
and hormones.
http://www.diabetesincontrol.com/modules.php?name=News&file=p-
rint&sid=2509
TC